Herrick and Heart Disease

Charles Stewart Roberts.

At the 1912 meeting of the Association of American Physicians, James B. Herrick read a paper
entitled "Clinical Features of Sudden Obstruction of the Coronary Arteries," which is now
considered a classic. For Herrick, however, the event was a disaster:
In 1912 when I arose to read my paper at the Association, I was elated, for I knew I had a
substantial contribution to present. I read it, and it fell flat as a pancake. No one discussed it
except Emanuel Libman, and he discussed every paper read there that day. I was sunk in
disappointment and despair. (Means, 1961)
It was not until Herrick readdressed the same association in 1919 that his views finally received
proper attention.
Born in Oak Park, Illinois, in 1861, Herrick graduated from the University of Michigan in 1882
and taught English, Latin, and Greek for several years in a high school. He graduated from Rush
Medical College in 1888 and interned at Cook County Hospital. He entered practice in Chicago
in 1890 and was appointed to the staffs of Cook County Hospital and Presbyterian Hospital. His
first book, A Manual of Medical Diagnosis, was published in 1895 when he was age 34. In 1900
he decided to engage only in consulting and became widely known as a master clinician and
teacher. Aside from his accomplishments in cardiology, Herrick called attention to anemia
secondary to chronic blood loss in 1902, and wrote the first description of sickle cell anemia in
1910.
The prevailing opinion of coronary obstruction in Herrick's early years was that it usually
resulted in sudden death because the coronary arteries were believed to be end arteries, lacking
sufficient anastomoses. Conheim lent support to this pessimistic view of coronary obstruction;
Herrick disagreed, writing:
Obstruction of a coronary artery or any of its large branches has long been regarded as a
serious accident. Several events contributed toward the prevalence of the view that this condition
was almost always suddenly fatal But there are reasons for believing that even large
branches of the coronary arteries may be occludedat times acutely occludedwithout
resulting death, at least without death in the immediate future. Even the main trunk may at times
be obstructed and the patient live. It is the object of this paper to present a few facts along this
line, and particularly to describe some of the clinical manifestations of sudden yet not
immediately fatal cases of coronary obstruction. (1912)
Herrick's medical experience at the bedside enabled him to differentiate clinical manifestations
of coronary obstruction when no one had before. His classification consisted of the following
four events: (1) instantaneous, perhaps painless, death; (2) severe angina followed minutes later
by shock and death; (3) mild, nonfatal angina; and (4) severe angina that is usually eventually
fatal, but not immediately. Herrick concluded with an insight concerning a therapeutic dilemma
that remains today: "The hope for the damaged myocardium lies in the direction of securing a
supply of blood through friendly neighboring vessels so as to restore so far as possible its
functional integrity". Herrick advocated use of digitalis instead of nitrates in the treatment of
sudden coronary obstruction and recommended bed rest for 6 weeks.
In 1930 Herrick received the Kober Medal for distinguished research in medicine conferred by
the Association of American Physicians, and in 1939 he received a Distinguished Service Medal
from the American Medical Association. His bibliography includes at least 163 medical articles
and 9 papers presented to the Chicago Literary Club. Apart from his classical scholarship,
Herrick was interested in medical history. In 1942 he published A Short History of Cardiology,
which covered the subject from Harvey to Roentgen. In a review of the book, Paul Dudley White
wrote:
The next to the last chapter, devoted to coronary disease, is of particular interest in its attempt to
explain the lapse in interest in the subject between 1900 and 1912 Sudden deaths and
temporary invalidism from heart disease, were occurring commonly throughout that century,
pathologists were finding scars in the heart and other evidences of serious coronary disease, but
there was no clinician to put all the facts together until Herrick himself analyzed the problem.
The occasional references in the literature to which he himself refers, although interesting, and
of course accumulative, nevertheless do not take away in my mind at all from the luster of
Herrick's own accomplishment in his classic paper in 1912. The only outstanding omission in the
book as I see it is the lack of recognition of the importance of his own contribution. It
undoubtedly is from sincere modesty. (1942)
Herrick described much of his life in his Memories of Eighty Years, in which he mentions his
first encounter with Osler in 1898: "A more inspiring, delightful hour I had never spent. I had
fallen victima willing oneto the charm of the Osler personality." Herrick died in 1954,
having read everything written by Chaucer, his favorite author.
References
1. Herrick JB. Peculiar elongated and sickle-shaped red blood corpuscles in a case of severe
anemia. Arch Intern Med. 1910;6:51621. [PMC free article] [PubMed]
2. Herrick JB. Clinical features of sudden obstruction of the coronary arteries. JAMA.
1912;59:201520. [PubMed]
3. Means JH. The Association of American Physicians: its first seventy-five years. New
York: McGrawHill, 1961:108. [PubMed]
4. White PD. Book review: A short history of cardiology. By Herrick JB. JAMA 1942;202
3.